Mandatory reporting in child protection - it still remains a controversy

The following is from a briefing paper I wrote for an organization in India where there is some discussion about introducing mandatory reporting laws. It is still controversial. In Canada and the United States we have had them for many years and we forget that they have been both beneficial and harmful.

Introduction

Mandatory reporting to child protection authorities (CPS) is an issue that receives consideration in various jurisdictions. The essence of it is that certain persons or professionals are mandated to contact CPS when they believe that a child is at risk as a result of abuse and, in some cases, neglect.

The purpose of this briefing paper is to review the main arguments for and against the use of this tool. Such reporting is typically embedded within child protection legislation by the competent authority, In some countries, that may be a national mandate whereas in others, it is the responsibility of state or provincial governments.

Context for Mandatory Reporting

The moral and ethical basis for seeking to bring in mandatory reporting is that children who are being subject to harm, from parents or other guardians, deserve to be protected. In this context, it is thought that the state should perform this role when those who are otherwise entrusted to care for a child show themselves to be unable to do so.

Intervention by the state is often thought to be an action that should be taken with extreme care, as most nations with child protection systems believe that family should be the primary unit to raise children. The state should only intervene when the family cannot or will not do that. Even then, child protection legislation will typically focus on efforts to preserve the family unit. CPS social workers will have, as a mandate, to intervene with a goal of helping the family to stay together. When children are removed from the family, the goal will be to return the children to family care as soon as possible with intervention aimed at correcting whatever caused the children to be temporarily removed. Severing parental rights to raise their children is considered a last resort.

The notion is that CPS should use the least intrusive option available. The best interest of the child is thought to reside in the family, which is an underpinning of many cultural beliefs about family.

Families who are abusive or neglectful to their children would not typically seek out the attention of CPS. Thus, mandatory reporting has been framed as a way to ensure that these families are brought to attention so that children can be protected.

Present Mandatory Approaches

Mandatory reporting is used in several Western countries who have highly developed child protection systems. This includes Canada, Australia, and The United States. As Matthews & Kenny (2008) note, it is these three countries who are most invested in this approach.

Matthews & Kenny (2008) report that there are other countries which have some form of mandatory reporting legislation. These are outline in Table 1. Some of these countries do this by policy as opposed to legislation. Others have a voluntary system.

Mandatory by Legislation or Policy

Argentina, Armenia, Bangladesh, Belarus, Benin, Bosnia and Herzegovina, Brazil, Bulgaria, Canada, Chile, Columbia, Democratic Republic of Congo, Denmark, Egypt, England, Estonia, Ethiopia, Finland, France, Honduras, Hungary, Iceland, Israel, Italy, Japan, Republic of Korea, Lebanon, Malaysia, Mauritius, Mexico, Mongolia, Montenegro, Nepal, Peru, Philippines, Portugal, Romania, Russia, Rwanda, Serbia, South Africa, Spain, Turkmenistan, USA, Zambia

Voluntary Reporting Systems

Cameroon, China, Germany, India, Netherlands, New Zealand, Pakistan, Saint Lucia, Scotland, Singapore, Sri Lanka, Togo

Table 1: Reporting systems by legislation, policy or on a voluntary basis – Source: Matthews & Kenny, 2008

It is apparent in Table 1 that there are nations identified with poorly developed child protection systems.

Countries that use this reporting mechanism place an obligation on various professionals (such as doctors, teachers, social workers, psychologists, dentists and so on) while others also place an obligation upon all citizens.

It would appear that other countries have felt that this approach lacks evidence of effectiveness. Others feel that this approach has a tendency to increase the conflict between a family and the state, thus reducing the effectiveness of interventions.

Arguments in Favour

The prime argument is, as noted above, the need to protect children from abuse and neglect when primary carers are unwilling or unable to do so. While legislation demanding reporting cover all children who would fall within the child protection legislation, the main focus is around small children who would be otherwise incapable of telling about the abuse.

Yet, for older children, the harm may have become so normalized for them that they are unable to recognize that what goes on in the family is harmful.

A third argument is that children are often hidden within the family structure. Therefore, the risks that they live through are typically invisible to the larger society. When a professional finally sees them, the harm may have been going on for some time. The child may still be reluctant to disclose and thus it is up to the professional, as opposed to the child, to then take steps to protect.

It might also be argued that, in the absence of mandatory reporting, professionals may be very reluctant to report for fear that they will alienate the child and / or the family. The case vignette in box 1 illustrates the point. Professionals can feel very much caught in a bind between their loyalty to the child and family versus a professional obligation. Mandatory reporting takes the professional out of that bind.

There are other arguments that also favour this approach. Mandated professionals will tend to know the family circumstances or the risk factors in a way that leads to better and more detailed referrals to child protection. Thus, when a case is reported, the case has a far higher probability of being one that should truly matter to CPS.

 Dr. Paul Johnston has been seeing Evan, a 4 year old boy, as his patient since Evan was born. He has also been the family doctor for his mother, Betty, now 26 years old, since she was a teenager. Dr. Johnston has had some concerns with her parenting although feels that he has been able to give her good advice. While Evan has been a bit behind on his developmental milestones, with his advice, Betty has been trying to ensure that Evan gets the support he needs.

However, for the past 2 visits, Evan has had bruising on his stomach and buttocks that Betty says is the result of Evan falling while playing. To Dr. Johnston, these explanations do not seem to make sense given the injuries.
She has also told him that she has a new boyfriend living at the house. She says that Evan does not like him.
Dr. Johnston suspects that the new boyfriend is hitting Evan. He fears that if he calls child protection that Betty will be upset and stop coming to see him. He believes that he has a good relationship with her and has been able to help her be a better parent.
BOX ONE

The argument further goes on to suggest that the professional can then be used as an ally to help build better and more effective interventions given their knowledge of the family.

For many legislators, the approach has appeal as they can be seen as taking concrete steps to protect children. In general, this may then receive broad support in the community. It could be seen as offering a symbolic message to the community that abusive and neglectful behavior by caregivers should not be tolerated,

For many professionals, such legislation has a significant protection. They are typically protected from allegations of professional misconduct if they report in accordance with mandatory reporting guidelines.

Proponents of mandatory reporting suggest that it has the ability to increase the awareness of child abuse in the larger community. Thus, it can serve both awareness and prevention purposes. There are also those who would look at some of the major scandals of recent years such as the Sandusky matter in the USA, the Catholic church and other clergy in various parts of the world and the Boy Scouts in Canada and the USA as proof that mandatory reporting laws are needed. Yet some of those cases occurred in jurisdictions with such laws in place.

Arguments Against

Perhaps one of the most significant arguments that can be mounted is that mandatory reporting must be connected to a responsive child protection system that can effectively assess and intervene. If a system cannot manage the referrals, or if there is no effective system, then mandatory reporting becomes a futile effort. Building support of professionals, who are called upon to report, requires that they believe the cases are managed well. 

Reporters also fear that they will be identified leading to angry families then venting upon them. Many laws seek to protect the identity of the reporter. The context of the report can make it fairly easy for a family to determine who called child protection in many cases. In the same vein, it can also act as a barrier to families seeking help fearing that they will be reported to CPS (Munro & Parton, 2007)

Another barrier is when systems are over loaded and social workers face high caseloads. This means that reported cases may be poorly managed or not managed at all. Professionals will then wonder what was the value in filing a report in the first place.

This gets further compounded when the system receives more reports than it imagined would occur when mandatory reporting legislation was brought into place. Melton (2005) argues that abuse is a far more reaching problem than CPS can manage, particularly when neglect is included. This can get even murkier when cases that are being reported are a result of such societally systemic issues such as poverty and community disadvantage. There are also indicators that heavy mandatory reporting levels can result in serious cases being missed or receiving insufficient attention, to the detriment of the safety of the child.[1]

Other critics have argued that mandatory reporting, especially when it includes the public, leads to a number of cases being referred that simply should never be. Spiteful family members, former spouses, alienated parents can all become the source of reporting. This then causes limited CPS resources to be used for cases that should never be in the system.

A further argument against such a policy relates to the amount of training that is required to make such a system effective. Those that will be required to report need to understand what is required, to whom they should report and what they can expect will happen. Training costs are not one-time expenditures. People change, new people come, circumstances change – all leading to an ongoing training requirement. This can be expensive. Critics suggest that such monies are poorly spent, as there is little evidence that mandatory reporting actually reduces rates of child abuse and neglect (Centre for Social Research and Education, 2012). Training is also needed to ensure that there is some understanding about what is meant by various terms such as physical, emotional, sexual abuse as well as neglect. There may be other conditions that fall within the requirements that will also need explanation. Those who are required to report must understand what and when they are to do so.

The understanding of what constitutes abuse also changes over time. In some jurisdictions things such as exposure to criminal activity by parents, drug or alcohol dependency in the home, exposure to domestic violence are all examples of understanding that emerged in the relatively recent times. When mandatory reporting laws came into vogue in the 1970s and beyond, they followed the work of American pediatrician C. Henry Kempe and his colleagues who wrote about the Battered Child Syndrome (1962). They were concerned with physical abuse. Today, a much broader range of behaviors is of concern.

There also remains a question about what level of suspicion is required for a report to be made (Matthews & Kenny, 2008). Many who report may be quite confused about when a case crosses that threshold. These same authors also raise the question of the suspected timing of the abuse. Is it reportable if the abuse occurred at some time in the past or must the risk be a current one?

There are also forms of abuse that occur outside the family. Sexual abuse is such an example. The West has seen a series of very high profile cases that involve media personalities, coaches and clergy, for example. Critics worry about how far reaching child protection reporting should be as opposed to matters that more properly might be the domain of the criminal justice systems.  

Even for matters occurring within the family, there must be clarity as to who is to be included in such legislation or policy. Many might feel comfortable that a report under such laws should include a parent harming a child. What, however, if the perpetrator is a sibling? There are many approaches.

What about research on effectiveness?

There is little hard data that suggests mandatory reporting reduces the impact of abuse and neglect or benefits child protection systems (Centre for Social Research and Evaluation, 2012).  The Australian Doctor’s Fund (2009) reported that they were unable to find any substantial research evaluating the impact of mandatory reporting. What research does exist suggests that mandatory reporting leads to high case loads with large proportions of reported cases being unsubstantiated. Yet, valuable resources were undertaken in order to investigate the unsubstantiated cases (Delfabbro, Hirte, Wilson & Rogers, 2010).

Some data suggests that reporting to CPS is often more focused on disadvantaged and marginalized populations (Choate, 2013).

What would need to happen?

If a mandatory reporting system were to be introduced, there are several steps required:

·      Legislation would need to be clear on what is to be reported by who and to whom. The legislation will also need to be clear on the definitions of terms such as abuse, neglect, maltreatment and so on. It must also carefully articulate the persons who could be reported upon;

·      There needs to be a vibrant, structured child protection system that is capable of receiving, investigating and managing referrals as well as the follow up with cases where abuse is substantiated;

·      Training is required for all professionals who would be covered by the reporting requirement. This would need to be complex ensuring that reporters fully understood their obligation as well as the thresholds. Legislation is often vague leaving professionals unsure about the criteria;

·      Effective inter-agency communication protocols that ensure data can be shared with child protection workers and related care professionals;

·      Mechanisms for effective case load management. This would include means by which reports that come in from various sources can be collated allowing the investigator to build a comprehensive picture;

·      Follow – up procedures with mandatory reporters in order to build faith in the child protection system; and

·      Intervention services that are designed to assist families to correct and manage parenting risks.

References:

Australian Doctor’s Fund. (2009). Mandatory reporting – Does it work?  Author.

Centre for Social Research and Evaluation. (2012). Mandatory reporting: Literature snapshot – July 2012. Auckland, NZ: Ministry of Social Development.

Choate, P.W. (2013). Parents with Fetal Alcohol Spectrum Disorders in child protection systems: Issues for Parenting Capacity Assessments. First People's Child and Family Review, In press.

Delfabbro, P., Hirte, C., Willson, R. & Rogers, N. (2010). Longitudinal trends in child protection statistics in South Australia. Children Australia, 35 (3), 4-10.

Harries, M. & Clare, M. (2002). Report for the Western Australian Child Protection Council: Mandatory reporting of child abuse: Evidence and options.  Discipline of Social Work and Social Policy: University of Western Australia.

Kempe, C.H., Silverman, F., Steele, B. Droegmueller, W. & Silver, H. (1962). The battered child syndrome.  Journal of the American Medical Association, 181, 4-11.

Matthews, B. & Kenny, M.C. (2008). Mandatory reporting legislation in the United States, Canada and Australia: A cross-jurisdictional review of key features, differences and issues. Child Maltreatment, 13, 50-62. http://doi.dx.org/10.1177/1077559507310613    

Melton, G.B. (2005). Mandated reporting: A policy without reason. Child Abuse and Neglect, 29, 9-18. http://doi.dx.org/10.1016/j.chiabu.2004.05.005  

Munro, E. & Parton, N. (2007). How far is England in the process of introducing a mandatory reporting system? Child Abuse Review, 16, (1) 5-16.  http://doi.dx.org/10.1002/car.973

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[1] The author is presently conducting research in this area. This is one of the preliminary themes found in the data.

Child maltreatment and the brain

New research shows that the brain is affected by childhood maltreatment and abuse. What is fascinating about the work is that different parts of the brain are affected by different forms of abuse. The research has just been published in the American Journal of Psychiatry.The implications are the risk of life long changes that will impact a person is some specific ways.

The research was summarized is a recent Science Daily report.

The results showed a correlation between specific forms of maltreatment and thinning of the cortex in precisely the regions of the brain that are involved in the perception or processing of the type of abuse. Specifically, the somatosensory cortex in the area in which the female genitals are represented was significantly thinner in women who were victims of sexual abuse in their childhood. Similarly, victims of emotional mistreatment were found to have a reduction of the thickness of the cerebral cortex in specific areas associated with self-awareness, self-evaluation and emotional regulation.

The clinical implications are immense. The brain is changed in order to deal with the trauma but then changes how the person adapts to life and subsequent situations that may not be directly related to the abuse. This helps us to understand why people are triggered to events that my be similar in some way to the abuse. While the brain changes may have been adaptive during the abuse, they can set up maladaptive outcomes for later life in behavioral and / or health facets of the victim's life.

Reference

Christine M. Heim, Helen S. Mayberg, Tanja Mletzko, Charles B. Nemeroff, Jens C. Pruessner. Decreased Cortical Representation of Genital Somatosensory Field After Childhood Sexual Abuse. Am J Psychiatry, June 1, 2013

Depressed parents and the child welfare system - a case of presumptive bias?

There is a large body of research that says that depression negatively impacts the ability of a parent. This includes lack of emotional availability to children; physical and emotional neglect as well as some connection to child abuse. This research has created a presumptive bias that a depressed parent is likely to be a risk to a child. Child protection workers can then lean towards more intrusive interventions. The bias gets greater with other forms of mental illness such as psychosis, bipolar disorder or the more severe forms of anxiety.

It is with that background in mind that I came across a recent Australian qualitative study that looked at the capacity of parents with mental illness. Boursnell (2012) sought to understand how parents with mental illness manage it and the parenting role. She reviewed the literature which identifies that mental illness is often seen as a risk factor in child protection matters. She further acknowledges that, when it can be shown that the illness does indeed prevent a parent from meeting minimum standards, then interventions are needed that may lead to the removal of children from the family.

There is also research that suggests that children raised in families with a mentally ill parent are at greater risk for problems with school, social relationships, links to the community as well as higher risks for substance abuse problems.

However, Boursnell also notes that much of the literature considers parents with quite severe mental illness including those who have been hospitalized. What then, she explores, about the many who are managed within the community utilizing voluntary services?

In those populations, the development of a solid working relationship between a social worker and the parent can allow a more strengths based approach in which the actual capacity of the parent might be considered. This might move the worker beyond the presumptive bias. There are many parents who might be able to successfully sustain the role of parent with appropriate community supports.

Many social workers are under pressure with high caseloads making it hard to build those relationships. This makes a risk oriented view of a parent with mental illness more probable. It also acts as a deterrent for parents getting involved in support programs.

While the article does not tell us that parents with major mental illness are not a concern, it does tell us that there is a need to be cautious about presuming mentally ill parents cannot parent.

Reference:

Boursnell, M. (2012). Assessing the capacity of parents with mental illness: Parents with mental illness and risk. International Social Work, In press.  http//:dx.doi.org.10.11770020872812445197

Do interventions reduce recidivism in child protection?

The idea of writing about the impact of therapy in child protection cases seems somewhat mundane. However, a recently published study by Soloman and Asberg (2012) looked at the issues of child protection interventions and recidivism, or the revolving door. The reality is that there is not a significant research base on this topic. Thus, the contributions from these authors is welcome.

There were a couple of areas that particularly struck me. Past research tells us that isolation is a risk factor in child protection cases. These authors tells us that the creation of social support networks can help to reduce recidivism. Giving parents therapy to help them address such things as mental health, emotional issues, trauma and substance abuse also helps to reduce recidivism. While this might make intuitive sense, it is nice that research is quantifying the impact.

A major finding is seen on p. 2316:

Overall, findings suggest that cases with at least one minority caregiver and cases in which caregiver(s) have received therapy are less likely to involve abuse or neglect recidivism, while cases in which children were temporarily taken from their caregivers' custody
are nearly nine times more likely to involve abuse or neglect recidivism. Although some studies found that neglect cases have higher recidivism rates (e.g., Hindley et al., 2006), this association was not found in the current study.

While this study has a skewed sample, it does tell us that some of the assumptions that have been held as true, may not be universally so. There may be sub samples where the assumptions prove untrue, as the above quote suggests

The point here is that each case must be considered on its own merits. It also tells us that each case should have a unique case management plan that reflects what might be done to assist families. This study does affirm that therapy is a worthwhile endeavour. The reason might well be that it helps parents deal with stress which is strongly related to the frequency of abuse. Parents who are unable to manage stress that pushes them towards their coping limits are more prone to abuse. This includes rates of neglect. Therapy can increase the coping skills which then reduces risk.  Consider what the authors states on p. 2312:

It has been found that 30% of investigated child maltreatment cases involve at least one
instance of recidivism within 3 years from the original index event (Connell et al., 2009), and these rates of re-referral to CPS seem to continue to climb as more time passes, with life-time re-referral rates upward of 40% (Connell et al., 2007; Drake, Jonson-Reid, Way,

& Chung, 2003) or 50% (English, Marshall, Brummel, &; Orme, 1999).

If therapy can reduce these recidivistic patterns, it is worth continuing to try. Children who are subject to repeated apprehensions and placement into foster care do worse. Can therapy help, this study suggests possibly so.


Reference

Soloman, D. & Asberg, K. (2012). Effectiveness of child protective services interventions as indicated by rates of recidivism. Children and Youth Services Review, 34, 2311-2318 http://dx.doi.org/10.1016/j.childyouth.2012.08.014

Oxford child sexual abuse scandal

Child protection again finds itself under scrutiny as a result of the failure to protect girls caught up in a sexual abuse ring.

Oxford gang members: (top left to right) Akhtar Dogar, Anjum Dogar, Kamar Jamil, Assad Hussain, (bottom left to right) Mohammed Karrar, Bassam Karrar and Zeeshan Ahmed who were found guilty of child sexual exploitation. Photograph: PA

Some of the girls who have come forward tell stories of classical grooming behaviours that led to them be enslaved within the power of the men who ran the ring. One of the girls gave the British newspaper, The Guardian, an exclusive interview. In it, she states:

She described how the gang began to abuse her when she was 13, plied her with crack cocaine and threatened to cut off the head of the baby she had by one of her abusers if she ever tried to escape them.

What perhaps is most disturbing about this case is that it did not occur without the knowledge of the social service and police agencies. The Guardian goes on to state:

A litany of failings by police and social services had allowed the men between 2004 and 2012 to groom young, vulnerable girls they met on the streets, outside schools and in cafes, entice them with the promise of alcohol and trinkets, and subject them over years to sexual atrocities and torture....

Girl C said her adoptive mother went to social services in 2004 to beg for help. She said: "Mum wrote to all the key people in social services, called her own case conferences, invited agencies and got them sitting around the table, but they just passed the parcel between them – and all the while, I was getting increasingly under the power and influence of the gang."

It is astonishing on one level that this could go on. There will be a Serious Case Review which may help us to better understand why. But there are some common themes arising in this matter. Perhaps the one that stands out for me is the failure of organizations to  collectively gather what was happening and build a coordinated response. Agencies are prone to see problems such as this belonging to the jurisdiction of another. There may well be shared responsibility. Silos in child protection work run directly contrary to the needs of children whose problems and situations often cross mandates of various agencies. Silos are simply dangerous for the well being of children. To illustrate this point, the Chief Constable in Oxford stated:

She said the cases were originally looked at individually. "I don't think we understood the extent that the abuse was systematic and it was organised," she said. "It was only when we sat down, pooled our information with that of the social workers, that we began to piece together the picture which explained what was happening in terms of this criminal network in Oxford."

This raises another area of concern which is looking only at cases in isolation as opposed to looking for the trends.

A fundamental principle of social work is to see the person within an environmental context. That means looking at not only the facts of the particular case but also the context in which the person is operating. In this case, a troubled girl (as she would be in prostitution and drug addiction) but those behaviours do not exist in isolation.

One hopes that the various authorities did not just see a troubled girl and a mother who wasn't an effective parent. Hopefully, the inquiry will also look beyond such possibly narrow views and see why the systems failed these girls.

Finally, one has to ask about leadership. Uncoordinated work such as appears to exist in these cases, will too often be the result of weak leadership both locally and beyond. This includes managers who are not giving the strength of supervision needed for cases like this but also funding and policy issues that make co-ordinating this work challenging. Limited resources tend to narrow the focus of workers to what can and must be done immediately. This is not an excuse but should encourage those that will do the SCR to look beyond the local issues. That too requires leadership.